Accounting for 60% of your Final Score for 2017, this category aims to prioritize and reward providers for the quality of their patient care based on evidenced-based measures.
The Quality category has two sets of measures:
- The CMS-calculated measures that are currently determined as part of the Value Modifier (VM)
- Measures submitted by providers
In 2017, CMS will use just one measure to contribute to your Quality Score: All-cause Hospital Readmissions (ACR). In the future, CMS-calculated measures may include scores for Acute Conditions Composite and Chronic Conditions Composite. The Acute Conditions Composite is made up of scores related to hospital admissions for bacterial pneumonia, urinary tract infections and dehydration. The Chronic Conditions Composite score is made up of diabetes, chronic obstructive pulmonary disease or asthma and heart failure.
Measures Submitted by Providers
The quality measures submitted by providers replace the Physician Quality Reporting System (PQRS), which required clinicians to report on nine measures across three domains. Under MIPS, providers only need to report on six measures, including one outcome measure. If an outcome measure isn’t available, selecting another high priority measure is an option.
There will be more than 200 measures to choose from, with 80% being tailored toward specialists who often have a difficult time when it comes to finding suitable measures. CMS has developed a series of specialty measure sets to further help providers select ones that are meaningful and within their scope of practice.
PQRS Measure Groups, with their requirement to report on just 20 patients, is no longer an option.
In 2017, the performance period is just 90 days to earn an incentive. The performance period will increase in future years of MIPS. To prepare for more rigorous reporting requirements, CMS strongly encourages practices to report for a full year, but a full year of data will not increase the incentive.
For Registry reporting in 2017, you must report on patients from all payers that are eligible for the measure, not just patients with Medicare Part B insurance. In future years, the completeness criteria for Registry reporting will increase to a full year of data for 90% of all eligible patients that meet the denominator criteria for the measure for all payers.
The score on the measures will be compared to national benchmarks and each measure will receive 0-10 points within this performance category based on which decile they fall into relative to the benchmark.
For 2017, every measure reported has a “floor” of 3 points, no matter how far from benchmark.